Concierge Medicine For $10 A Month? Yes, It's Possible.

Say the words “concierge medicine” and most Americans will envision the kind of extravagant medical care reserved only for the rich and famous.

A recent article in The New York Times lent some credence to this perception, revealing that a handful of elite patients are paying $40,000 to $80,000 annually for the right to hand pick their doctors, bypass waiting rooms and get their care inside lavish facilities that could easily be mistaken for high-end hotels.

Lost in the opulence of “red-carpet” care are two surprising facts. First, these types of convenient medical services – stripped of their pomp – could be delivered at a fraction of the price to average Americans (who today wait 29 days to see their family care physician). Second, if insurance companies were willing to pay the up-front fees, the total cost of health care would actually decrease.

What Is Concierge Medicine, Really?

It may sound luxurious but concierge medicine refers simply to an arrangement between a patient and a primary care physician, one usually trained in internal or family medicine. The doctor charges a monthly or annual fee and, in return, is expected to be available around the clock.

For most physicians, the thought of being on call 24/7 would be terrifying at any price. But if doctors and patients thought differently about concierge medicine – not as a single physician working alone, but as a coordinated team of primary care physicians all working together, armed with the latest information technology – both parties would benefit immensely.

The Mathematics And Benefits Of Concierge Medicine

Health care costs vary across the United States, but the simplest way to pinpoint an average is to divide total health care expenditures by the total population. The result is $10,345 annually per person. Very little of that is spent on primary care.

Primary care physicians earn on average between $200,000 and $250,000 a year. To do so, they must collect $400,000 to $500,000 annually to offset the overhead of their practice (i.e., office space, staff, equipment and so on). To generate that much revenue, doctors care for a “panel” of around 2,000 patients and typically see 20 or more at their office on any given day. All told, primary care services account for less than 3 percent of the total cost per patient, approximately $200 to $250 of the total $10,345 annual sum.

Now, imagine the improvements in personalized service and health care outcomes if doctors halved their patient panels to around 1,000, with just 10 visits per day. Physicians would get to spend twice as much time with each patient but, of course, they would experience a major financial loss.

That is, unless insurance companies and physicians made the following changes and, in doing so, provided all Americans with a 21st-century form of concierge care.

1. Physicians would need to offer patients the most modern information technology.

Most doctors can’t bill for their services unless they see patients in the flesh. That’s why nearly all primary care is provided in an office and why very few patients can email, text or participate in “video visits” with their physicians.

But if an entire team of primary care physicians rotated throughout the day, using these digital tools along with a comprehensive electronic heath record, fewer patients would be forced to leave work, school or home to get the care they need. Many patient problems could be treated virtually and rapidly, rather than in emergency departments. In fact, data out of the MidAtlantic Permanente Medical Group demonstrate that connecting doctors and patients through video visits can diminish the need for emergency-department visits on nights and weekends by as much as 60 percent.

2. Insurers would need to rebalance the economics of medicine.

Primary care represents about 1/40th of the health care expenses that go into the $10,345 spent annually on each American’s health care.

As insurance companies continue to ratchet down payments for primary care, doctors are forced to see more patients every day while opportunities to improve health get overlooked.

To rebalance the cost ratio, doctors would need to be prepaid for their care, including a $10 monthly “concierge-equivalent fee” per patient, paid for by insurance companies. This fee, combined with the reduced overhead resulting from seeing fewer patients, would allow physicians to maintain their revenues. But why would insurers agree to foot the bill?

By doubling the length of their appointments, physicians would have the time needed to focus on preventive medicine and help patients make the kinds of important lifestyle changes that could prevent further complications from chronic illnesses. With improved health, the need for emergency hospitalization and specialist care would diminish further, potentially saving the health care system billions of dollars.

For example, look at high blood pressure, which remains the leading cause of stroke in the United States. According to the Centers for Disease Control and Prevention (CDC), only 54 percent of American patients have their blood pressure under control. But among the large multispecialty medical groups that count themselves as members of the Council of Accountable Physician Practices (CAPP), the hypertension control rate is close to 90 percent. Almost all of these groups have a higher primary-care-to-specialist ratio than the average, and they’ve made meaningful investments in both disease prevention and technologically enabled medical care.

The Barriers To Concierge Medicine

If this approach and its outcomes seem so logical, why haven’t more insurers embraced it? Three reasons:

First, it takes five to 10 years to accrue the savings of a healthier population. For most insurance companies with a short-term outlook on cost savings, that’s a problem, particularly when patients change carriers frequently.

Second, change in medicine happens slowly. Our delivery system model is a hold-over from the last century and is poorly equipped to manage the fairly recent surge in chronic illness. The culture of medicine values intervention over prevention. And as more money gets funneled into specialty and emergent care, insurance companies increasingly view primary care not as a value creator, but as a cost center.

Finally, there’s a national shortage of primary care physicians. The reason is once again wedded to the past. The financing of residency training is a legislative relic that favors training specialists over primary care physicians. As a result, less than one-third of American doctors specialize in primary care, contrary to other countries with dramatically better quality outcomes. Achieving the optimal ratio would take years.

The Folly Of The $40,000 Copay

When I read that article in The New York Times, I could not imagine why anyone would pay tens of thousands of dollars for a concierge physician. Except under extreme circumstances, patients just don’t need that much access to a doctor. Most importantly, there is no evidence these high-priced services offer anything better than a group of experienced, well-trained primary care physicians could.

Primary care physicians can’t do everything, but if they had twice the time for their patients and reasonable reimbursements, they could accomplish so much more. It would be one good prescription for what ails our nation, an important step in the transformation of American health care.